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The Current Status of Online CME

The Current Status of Online CME. Presented at ASCO Critical Issues Seminar Santa Fe, New Mexico March 17, 2000 Bernard Sklar MD University of California, San Francisco bersklar@netcantina.com. A Talk and a Resource. This talk is posted on the web at www.netcantina.com/slideshows

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The Current Status of Online CME

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  1. The Current Status of Online CME • Presented at ASCO Critical Issues Seminar • Santa Fe, New Mexico • March 17, 2000 • Bernard Sklar MD • University of California, San Francisco • bersklar@netcantina.com

  2. A Talk and a Resource • This talk is posted on the web at www.netcantina.com/slideshows • There are several versions to choose from, depending on your browser, speed of connection and your preference for html or PowerPoint • Please visit the presentation as often as you like, follow the links and study the sites. Feel free to adapt the presentation for your own use. • If you use it, please say ”Adapted from a talk presented at ASCO Critical Issues Seminar, March 17, 2000, with permission of Bernard M. Sklar, M.D.”

  3. Online CME:Outline of this Talk • Focus: what is actually “out there” • (Briefly) History of the CME Movement • (Briefly) CME today without the Internet • Findings from my research and surveys • Speculations on the future of online CME

  4. History of CME in America • Medical life before mandatory CME • 31 states require 12-50 hours of CME per year • 11/28 specialty societies require CME for recertification • Most hospitals require CME to maintain hospital privileges • Many HMOs and Insurers require CME

  5. CME Accreditation • All CME is accredited by the ACCME (Accreditation Council for Continuing Medical Education) • COPE is the optometric equivalent of ACCME

  6. Non-Online CME • Live (80.4%): • Meetings at the hospital and specialty conventions • Teleconferences: radio, television or telephone • Home Study (18.6%): • Reading articles in medical journals • Home Courses which can consist of: Text, Audiotape, Videotape, CD-ROMs

  7. CME: Meetings • Most CME presented at meetings is not effective in changing MD behavior. • Peer-reviewed Journals: Often sponsored by specialty society

  8. CME: Journals • A common form of home-based CME is reading journal articles and answering quizzes based on these articles. • Journal reading and quizzes accounted for 30% of all home-based CME in 1998

  9. CME: Home Study • Home Study courses can be: • Text and graphics (AAFP) Home Study) • Audiotape (Audio-Digest Foundation) • Videotape (AAFP Video Series) • CD-ROM • ProEd International • ArcMesa Course in Oral Pathology

  10. AAFP-Home Study-Text Only

  11. Audio Digest Audio Tapes

  12. AAFP Video Series

  13. ProEd International CD-ROM

  14. LandesSlezak Multiple Formats

  15. CME Teleconferences • Physicians can join teleconferences from home, office or hospital • University or drug-company sponsored • Interactive with immediate feedback • Transmitted via telephone, radio or television • OMEN (Ohio Medical Education Network)

  16. Costs of Non-Online CME • Can be inexpensive • hospital meetings usually free, journals free to $15 per hour. Home Study $15 to 20 per hour. • Can be very expensive • specialty meetings at resorts, $500-1000 for credit, plus room, travel, meals and time away from practice • CME is big business • 500,000 physicians x 25-50 hours per year x $10-20 per hour = $125 to 500 million per year. And it is required.

  17. Online CME: A Solution? • IF properly produced and implemented, online CME can solve a number of problems: • Timeliness and ease of production • Cost and inconvenience to physicians • Proof of attendance • Assessment of learning

  18. Online CME My List

  19. Online CME: Types of Instruction • Text only or Text plus graphics • Slide-audio or Slide-Video lectures • Question/Answer • Guideline-Based • Non-Interactive • Interactive

  20. Online CME: Text-Only • The easiest kind of CME site to put up. Take your print article, convert it to HTML, add a few multiple choice questions, and post. • Articles can be long-20 to 50 pages. • Articles are usually in HTML or pdf format.

  21. Medbytes Allergic Rhinitis Text Only

  22. Medicine and Behavior Text Only

  23. Cine-Med Asthma Presentation Text-Graphics

  24. Online CME: Slide-Audio Presentations • Greater investment in time and technology • Record speaker during lectures • American Psychiatric Association: Choosing an Antidepressant

  25. American Psychiatric Assn-Slide Audio

  26. Online CME: Slide-Video Presentations • This technology works well with fast connections • Otherwise video picture can be “jittery” • The picture is also quite small • MedLecture.com demo • CME-WebCredits Diabetes

  27. MedLecture.com slide Video

  28. CME WebCredits.com

  29. Online CME: Guidelines • Several sites present treatment guidelines or “consensus” statements. • These two are text-only • NIH Consensus Statements (Brain Injury) • The “other” ASCO (antiemetics in cancer)

  30. NIH Consensus Statements (Brain Injury)

  31. American Society of Clinical Oncology

  32. Online CME: Interactivity • Best use (so far) of internet technology • Program waits for user input before continuing • Can be text only or can use audio or video • Examples: • Question/Answer • Case Based

  33. Influenza Vaccine Question/Answer

  34. Influenza Vaccine-Incorrect Answer

  35. Influenza Vaccine-Correct Answer

  36. Teenager with Wheezing, History • A 12-year-old male soccer player presents to your office because of a persistent cough occurring with exertion. Symptoms are worsened during cool weather. He denies shortness of breath or symptoms at rest. Family history reveals mild maternal asthma.

  37. Teenager with Wheezing, Vital Signs • Temperature: 98.2Blood Pressure: 115/70Pulse: 76Respirations: 12Lungs: Clear to auscultation bilaterallyHeart: Regular rate and rhythm, no murmurExtremities: No cyanosis

  38. Teenager with wheezing, Question • What is the most likely diagnosis? • A) Upper respiratory infection • B) Exercise-induced asthma • C) Chronic bronchitis • D) Pneumonia

  39. Teenager with wheezing, Correct Answer • If you give correct answer, program says” Correct” and gives no other feedback.

  40. Teenager with wheezing, Incorrect Answer • Answer B. The overall incidence of exercise-induced asthma is approximately 12% to 15%. Typical presentation may include a. coughing, wheezing, dyspnea, or chest discomfort with exercise; b. symptoms that vary by season or outdoor temperature; c. decreased or altered exercise regimen; d. complaints of limited endurance; and e. decreased problems in warm, moist environments. Patients at risk for exercise-induced asthma include those with: a. known asthma, b. allergic rhinitis, c. family history of asthma, and d. history of viral bronchitis.

  41. Interactive Online CME • Here’s a few more simple examples of interactive online CME for you to look at later if you wish • VLH Menstrual Disorders • Family Residents Interactive Abdominal Pain • Case Study in Congestive Heart Failure

  42. MS Thesis • I searched the web for online CME repeatedly over 3 years • As of early February 2000: • 96 sites • Over 3000 hours of CME credit • The number of sites found grew from 18 in December 1997 to 96 in February 2000

  43. MS Thesis: Size of Sites • 3/96 sites have greater than 200 hours • 6/96 sites have 50 to 100 hours • 56/96 sites have 5-49 hours • 31/96 sites have 5 or fewer hours

  44. MS Thesis: Types of Instruction • 27/96 (28%) Text-Only • 38/96 (38%) Text-and-Graphics • 22/96 (23%) Slide-Audio Lecture • 7/96 (7%) Slide-Video Lecture • 7/96 (7%) Guideline-Based • 4/96 (4%) Question/Answer • 16/96 (17%) Interactive

  45. MS Thesis: Fee Structure • 38/96 sites offered free instruction • 28/96 charged $10 or less per credit-hour • 20/96 charged $11-20 • 10/96 charged $21 or more

  46. MS Thesis: Physician Usage I • If you build it, will they come? • Requested usage information from all sites (43) offering 10 or more hours of credit • 23/43 responded with some useful information • A few commercial sites seem to doing well: • HealthStream • MedScape • Virtual Lecture Hall • ArcMesa

  47. MS Thesis: Physician Usage II • A few of the government sites seem to be doing well • MMWR • NIH Consensus Statements • One University Site doing OK • Cleveland Clinic, now allied with HealthStream

  48. MS Thesis: Physician Usage III • ACCME Report shows growth from 1997 to 1998 • 1997 - 13,115 physician-registrants • 1998 - 37,879 physician-registrants • 1999 not yet available

  49. MS Thesis • Many more details available by looking at the text of the thesis. • I’ll be happy to share those details • Contact me at bersklar@netcantina.com

  50. Quality Issues • I will discuss three systems for ensuring or measuring quality: HON (Health on the Net) Medical Matrix Silberg and Lundberg

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